A difficult decision: stopping treatment

Aug 1, 2014

When a patient has a terminal disease, 0ne of the hardest conversations to have is about when to stop treatment. This week, Lorraine Rapp and Linda Lowen, hosts of WRVO's health and wellness show "Take Care," interviewed Dr. Barron Lerner about medical directives. This week, they spoke to him how physicians and family members can bring up the topic about a patient's wishes for halting treatment. Dr. Lerner is a medical ethicist, author and professor at the New York University School of Medicine

Linda Lowen: In a perfect world, a patient who isn’t sound of body would still be sound of mind and could make the decision to discontinue treatment, but we don’t live in a perfect world.  How far are we from this type of scenario?

Dr. Barron Lerner: It varies very much case by case.  There are some situations where people are deteriorating in a way that could have been predicted and everyone’s on the same page in a sense.  There’s been some kind of a discussion, someone has cancer, they’re dying, [and they say] “let’s do this, let’s not do that,” but in many other cases there’s a curveball or something and something happens abruptly [or] something happens that’s surprising.  A person gets sick for example on vacation when they aren’t able to access their regular doctors and the family’s not around.  There [are] lots of scenarios that occur when there have to be difficult decisions made and the information may not be there.

Lorraine Rapp:   What kind of advice do you give people like family members on how to talk to the patient when it’s not so clear and you’re still a ways away from the end but you want to start getting the discussion going?

Dr. Lerner:  It’s very hard.  It’s a bummer to point out the bad scenario when you’re trying to focus on the hopeful scenario.  But I think it can skillfully be done [by] continuing to give patients reality checks over time and reminding patients that a particular treatment has a percentage chance of working and saying that even as we’re being aggressive, we’re going to keep things realistic.  Then, at least, you don’t have that surprise moment where the doctors seem to be throwing up their hands and changing their tune very abruptly.  That’s very disconcerting to patients. 

Linda Lowen: What would you say to a family, a patient, [or] the medical community struggling with this particular decision?

Dr. Lerner: I would say again [that] the main theme would be to try to facilitate open discussion.  I think the taboos about talking about this have been a problem over time.  I think trying to engage the patient and hearing things in their words early on [and] potentially getting them to write things down is so helpful.  The vast majority of patients in my experience have wanted to talk about this.  The number of people when I bring this up who say “I don’t want to talk about that” is very small.  Different people will comment more extensively and some people won’t fill out the forms and some people will, but usually people have thought about this.  They have seen loved ones in similar circumstances [or] they watch TV shows where these issues come up all the time, so it’s rarely an error to broach these subjects with pretty much anyone.

More of this interview can be heard on "Take Care," WRVO's health and wellness show Sunday at 6:30p.m. Support for this story comes from the Health Foundation for Western and Central New York.